Provider Demographics
NPI:1316172133
Name:LEE, JARED THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:THOMAS
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6110
Mailing Address - Country:US
Mailing Address - Phone:337-625-6711
Mailing Address - Fax:337-625-6711
Practice Address - Street 1:2500 MAPLEWOOD DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6100
Practice Address - Country:US
Practice Address - Phone:337-912-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor